The largest and most influential organization of American physicians has sent two stark messages to the Republican Party: Don’t mess with Obamacare until you know what you’re putting in its place. And don’t do anything that would backtrack on the law’s most important accomplishment ― bringing the number of uninsured Americans to a historic low.
The American Medical Association delivered these messages on Tuesday, in an open letter addressed to congressional leaders of both parties. But its intended audience was GOP leadership and members President-elect Donald Trump’s incoming administration who have said repealing the Affordable Care Act would be their first order of business.
Two days into the new congressional session, GOP leaders have already started the legislative process that would eventually allow them to kill Obamacare, by stripping out its funding and spending with simple majority votes in both houses. Vice President-elect Mike Pence met with GOP leaders, including House Speaker Paul Ryan, on Wednesday to discuss strategy and rally rank-and-file members.
But Republicans have promised for nearly seven years that they could replace Obamacare with something better, and even party leaders acknowledge that they have no consensus on how to do that.
In the letter, AMA CEO and vice president James Madara warned Republicans not to repeal the law until they could “lay out for the American people, in reasonable detail, what will replace current policies.”
“Patients and other stakeholders should be able to clearly compare current policy to new proposals so they can make informed decisions about whether it represents a step forward in the ongoing process of health reform.”
With its warning against a hasty repeal vote, the AMA joins a chorus that includes other industry groups and even some well-known conservative experts on health policy. But the AMA’s letter was striking in two key respects.
One was its explicit call for Republicans not to let the number of uninsured Americans increase again. “In considering opportunities to make coverage more affordable and accessible to all Americans, it is essential that gains in the number of Americans with health insurance coverage be maintained,” Madara wrote.
None of the serious Obamacare alternatives circulating in conservative think tanks or on Capitol Hill could meet that standard, except perhaps by offering insurance that left individuals more exposed to crippling medical bills.
The other striking element of the AMA letter was its insistence that Republicans reveal their replacement plan before repealing the law ― not simply to avoid the insurance chaos that a quick repeal vote could unleash, but also to give the public an opportunity to decide whether it actually prefers GOP-style health care to what exists now.
“We … recognize that the ACA is imperfect and there a number of issues that need to be addressed,” Madara wrote.
But, Madara went on to say, “patients and other stakeholders should be able to clearly compare current policy to new proposals so they can make informed decisions about whether it represents a step forward in the ongoing process of health reform.”
Doctors speaking up for expansions of health insurance might sound like the ultimate dog-bites-man story. But until relatively recently, the AMA hasn’t been a big cheerleader for government-run or government-managed health care plans.
On the contrary, in two of history’s biggest fights over health care reform ― President Harry Truman’s failed effort to create national health insurance in the 1940s and President Lyndon Johnson’s successful effort to create Medicare in the 1960s ― the AMA was among the most vocal and effective opponents of new laws.
Sentiments shifted over time, however, and the AMA, like most of the health care industry, ended up supporting the ACA. But the AMA still has a conservative streak ― it issued a quick, if ultimately controversial, endorsement of Rep. Tom Price (R-Ga.), Trump’s nominee for secretary of Health and Human Services.
Price, an orthopedist, is a leader of the GOP’s conservative wing. In addition to seeking Obamacare repeal, he has called for turning Medicare into a voucher program and dramatically downsizing Medicaid.